Home » Academic posts » Contraindications to Breast Conserving Surgery

Contraindications to Breast Conserving Surgery

Breast conserving surgery (BCS) is fast becoming popular but one should be aware of the the contraindications of this procedure in order to avoid high recurrence rates & complications.

Breast conserving surgery in simple words is lumptectomy (removal of the tumor with a normal rim of tissue). All patients following BCS require radiotherapy. Some of the contraindications of this procedure are related to the surgical aspect whereas others are contraindications for radiotherapy.

 

Absolute Contraindications

  1. Pregnancy – is a contraindication for radiotherapy, as it can lead to teratogenic effects.
  2. Two or more primary tumors in separate quadrants (multicentric tumors). Patients with multifocal tumors (two or more primaries in the same quadrant) can undergo BCS. [Fig 1]
  3. Diffuse malignant-appearing calcifications on mammogram 
  4. History of prior radiation to the breast area
  5. Persistent positive margins
  6. Inflammatory breast cancer

multifocal vs multicentric

 

Relative Contraindications

  1. History of collagen vascular disease – leads to increased radiotherapy associated complications
  2. Breast size to tumor size ratio [Fig 2] – Instead of the absolute size of the tumor, tumor/ breast ratio is a better indicator of whether the patient is eligible for BCS or not. Fig 2 – highlights two patients, both with identical tumor sizes but one patient has a large breast (leading to a small tumor/ breast ratio) whereas the other patient has a small breast (leading to a large tumor/ breast ratio). BCS is avoided in patients with large tumor to breast ratio as it leads to poor cosmetic outcome.

tumorbreastratio

 

Following are NOT contraindications to BCS:

  • Family history of breast cancer
  • Positive lymph nodes
  • Bilateral breast cancer
  • Lobular histology
  • Central quadrant tumor
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